You are NUTS!

Cathy YoungJewish World Review

"GET THEE to a therapist!" is the Surgeon General's mandate in a
just-released 500-page report on mental health. The report claims that more
than one in five Americans (22%) suffers from a "diagnosable mental disorder"
at any time, and laments that two-thirds don't seek treatment. This is
blamed on stigma and cost; the report endorses equal insurance coverage for
mental disorders and physical illness, a goal the Clinton Administration has
championed for some time.

As one might have guessed, pushing the number of sufferers to one in five
required defining mental illness down. To most of us, "mental illness" means
an extreme condition that makes a person incapable of functioning in daily
life: psychosis (loss of contact with reality) or major depression,
especially unrelated to depressing life events. But the "official"
definition includes mild depression and plenty more. The latest, 1994
edition of the Diagnostic and Statistical Manual of the American
Psychiatric Association (DSM-IV) lists more than 300 "diagnosable mental
disorders," compared to just 60 in the 1952 edition.

Has the psychiatric profession's knowledge of mental illness improved so
dramatically, or has its notion of what constitutes mental illness expanded
so dramatically? A look at some diagnostic criteria suggests the latter.
Narcissism, self-doubt, excessive devotion to work, obnoxiousness --
everything is a "disorder."

The latest rage is "social phobia." One survey
determined the prevalence of this disease by asking respondents if they
thought they were more nervous than other people when speaking in public or
attending large social gatherings, and if this bothered them a lot.

While the Surgeon General's report frets about "the public's reluctance
to pay for mental health services," its summary of poll data does not seem to
support this complaint: people show "greater willingness to pay for insurance
coverage for .... severe mental disorders, such as schizophrenia and
depression, rather than for less severe conditions such as worry and
unhappiness." Seems like -- pardon the pun -- a pretty sane approach.

The ballooning definition of mental illness should cause us worry and
unhappiness for at least two reasons.

First, medicalizing such a wide range of problems essentially reduces the
human condition to a clinical condition, undermining such old-fashioned
notions as character, self-reliance, and the human spirit. It's ironic: at
one extreme, there's an effort to "mainstream" people with truly severe
mental disturbances; at the other, any deviation from some white-bread norm
of stability is pathologized.

(Including, says the Surgeon General's report,
bereavement lasting more than two months!)

This evokes shades of Aldous
Huxley's Brave New World, where any unpleasant emotions were quickly
medicated away. The potential for coercive therapeutic intervention in
private lives is clear and disturbing.

The other danger is that vast sums of money may be spent on treatments of
dubious value. As John Horgan convincingly argues in his recent book The
Undiscovered Mind, science still knows very little about treating mental
distress. The field of psychotherapy is full of modern-day witch doctors
whose techniques (such as recovered memory therapy) may do more harm than
good. As for highly touted miracle drugs, studies show that while 50% to 60%
of patients on anti-depressants such as Prozac show an improvement, so do
30-40% of patients given a placebo pill. The effects for people with mild
depression may be especially negligible. What's more, the improvement is
often temporary.

In one fascinating study of depression treatments, reported in a 1995
article by University of Washington psychologist Neil Jacobson, some patients
took drugs, some had conventional therapy, and others met with therapists but
talked about subjects like sports or gardening rather than personal problems.

All three groups had fairly similar (and not very encouraging) outcomes: 20
to 30% recovered from depression and stayed well for the next year and half.

Unquestionably and tragically, many people with severe mental illness
that makes them dangerous to themselves and others are not getting treatment
that could help them. But let's not lump them together with those whose
problems could be addressed just as well by joining a gardening
club.

JWR contributor Cathy Young is co-founder and vice-president of the Women’s Freedom Network and author of Ceasefire! Why Women and Men Must Join Forces to Achieve True Equality. Send your comments to her by clicking here.